Healthcare Provider Details

I. General information

NPI: 1295559664
Provider Name (Legal Business Name): KEVINA WOODS MSN, APRN, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S. EASTERN AVENUE
LAS VEGAS NV
89104
US

IV. Provider business mailing address

1505 S EASTERN AVE
LAS VEGAS NV
89104-3916
US

V. Phone/Fax

Practice location:
  • Phone: 702-885-0881
  • Fax:
Mailing address:
  • Phone: 725-204-9548
  • Fax: 844-888-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number858165
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number858165
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: